How much rates vary
Distribution of negotiated rates across all payers (price axis is log-scale). Need provider-level prices or 24+ months of history? Contact us.
Rates by insurance carrier
| Insurance Carrier | Facility/Professional | Modifier | Typical Low | Median | Typical High |
|---|---|---|---|---|---|
Aetna Setting Facility Modifier None Typical Low $223.87 Median $398.11 Typical High $12,589.25 | Facility | None | $223.87 | $398.11 | $12,589.25 |
Aetna Setting Professional Modifier None Typical Low $109.65 Median $144.54 Typical High $416.87 | Professional | None | $109.65 | $144.54 | $416.87 |
Ambetter Setting Professional Modifier None Typical Low $112.20 Median $112.20 Typical High $112.20 | Professional | None | $112.20 | $112.20 | $112.20 |
Anthem BCBS Setting Facility Modifier None Typical Low $371.54 Median $794.33 Typical High $3,311.31 | Facility | None | $371.54 | $794.33 | $3,311.31 |
Anthem BCBS Setting Professional Modifier None Typical Low $67.61 Median $107.15 Typical High $186.21 | Professional | None | $67.61 | $107.15 | $186.21 |
CareSource Setting Facility Modifier None Typical Low $131.83 Median $1,174.90 Typical High $1,737.80 | Facility | None | $131.83 | $1,174.90 | $1,737.80 |
Cigna Setting Facility Modifier None Typical Low $50.12 Median $66.07 Typical High $794.33 | Facility | None | $50.12 | $66.07 | $794.33 |
Cigna Setting Professional Modifier None Typical Low $97.72 Median $141.25 Typical High $269.15 | Professional | None | $97.72 | $141.25 | $269.15 |
Medical Mutual of Ohio Setting Facility Modifier None Typical Low $50.12 Median $66.07 Typical High $794.33 | Facility | None | $50.12 | $66.07 | $794.33 |
Medical Mutual of Ohio Setting Professional Modifier None Typical Low $97.72 Median $141.25 Typical High $275.42 | Professional | None | $97.72 | $141.25 | $275.42 |
Molina Setting Professional Modifier None Typical Low $100.00 Median $141.25 Typical High $204.17 | Professional | None | $100.00 | $141.25 | $204.17 |
SummaCare Setting Professional Modifier None Typical Low $97.72 Median $144.54 Typical High $186.21 | Professional | None | $97.72 | $144.54 | $186.21 |
United Setting Facility Modifier None Typical Low $97.72 Median $275.42 Typical High $2,398.83 | Facility | None | $97.72 | $275.42 | $2,398.83 |
United Setting Professional Modifier None Typical Low $89.13 Median $134.90 Typical High $245.47 | Professional | None | $89.13 | $134.90 | $245.47 |
6 more rates with less common billing modifiers
A modifier changes what was billed, for example a reduced or repeated service. Each of these modifiers carries under 10% of the published rates for this code. Modifier combinations, and modifiers with fewer than 30 rates for a carrier, are not listed.
| Insurance Carrier | Facility/Professional | Modifier | Typical Low | Median | Typical High |
|---|---|---|---|---|---|
Aetna Setting Professional Modifier 52 · Reduced service Typical Low $53.70 Median $72.44 Typical High $72.44 | Professional | 52 · Reduced service | $53.70 | $72.44 | $72.44 |
Aetna Setting Professional Modifier 53 · Discontinued Typical Low $21.88 Median $28.84 Typical High $28.84 | Professional | 53 · Discontinued | $21.88 | $28.84 | $28.84 |
Aetna Setting Professional Modifier 54 · Surgery only Typical Low $81.28 Median $109.65 Typical High $109.65 | Professional | 54 · Surgery only | $81.28 | $109.65 | $109.65 |
Aetna Setting Professional Modifier 55 · Aftercare only Typical Low $16.22 Median $21.88 Typical High $21.88 | Professional | 55 · Aftercare only | $16.22 | $21.88 | $21.88 |
Aetna Setting Professional Modifier 56 · Pre-op care only Typical Low $10.96 Median $14.45 Typical High $14.45 | Professional | 56 · Pre-op care only | $10.96 | $14.45 | $14.45 |
Aetna Setting Professional Modifier 78 · Unplanned return to OR Typical Low $75.86 Median $102.33 Typical High $102.33 | Professional | 78 · Unplanned return to OR | $75.86 | $102.33 | $102.33 |
Where Ohio sits
The same service costs 4.2 times more in Alaska than in Kentucky. Every bar is a state, most expensive first. Touch or drag across it to read any state, then open that state for its carriers and full range.
Ohio· 45th of 51
$135
Median negotiated rate in each state, from every insurer that publishes one. States where no insurer publishes a rate for this service are not shown.